Provider Demographics
NPI:1235318395
Name:DOUGLAS E WRIGHT, MD, PA
Entity type:Organization
Organization Name:DOUGLAS E WRIGHT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-257-6601
Mailing Address - Street 1:PO BOX 294956
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-4956
Mailing Address - Country:US
Mailing Address - Phone:830-257-6633
Mailing Address - Fax:830-257-6620
Practice Address - Street 1:1001 WATER ST
Practice Address - Street 2:SUITE E200
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3523
Practice Address - Country:US
Practice Address - Phone:830-257-6633
Practice Address - Fax:830-257-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G80TOtherBCBSTX
TX00W214Medicare PIN